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A nurse in a substance use disorder clinic is explaining the alcohol recovery process to a client's family. Which of the following should the nurse identify as the first step toward successful recovery from alcohol use disorder?
- A. Form a close support network.
- B. Acknowledge an inability to control drinking.
- C. Incorporate a form of spirituality into daily life.
- D. Agree to a prescription for an alcohol use deterrent.
Correct Answer: B
Rationale: Acknowledging an inability to control drinking is crucial as it represents acceptance of the problem. Without this self-awareness, the individual is unlikely to seek or benefit from treatment options. This step is foundational, preceding the use of support networks, spirituality, or medication.
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A nurse is assisting with reminiscence therapy for a group of older adult clients. Which of the following strategies should the nurse implement?
- A. Making a unit calendar to promote orientation.
- B. Discussing childhood memories during group therapy.
- C. Encouraging thought-stopping to block undesirable thoughts.
- D. Playing board games with other clients to enhance cognition.
Correct Answer: B
Rationale: Discussing childhood memories fosters reminiscence, aiding in cognitive stimulation and emotional connection among older adults. This aligns with the goals of reminiscence therapy, unlike orientation aids or thought-stopping.
A nurse is caring for a client who has dementia and is experiencing an increased number of falls. Which of the following actions should the nurse take?
- A. Request a consult with recreational therapy.
- B. Lower the window shade in the client's room.
- C. Place the client in a room close to the nurses' station.
- D. Obtain a PRN prescription for a vest restraint.
Correct Answer: C
Rationale: Placing the client near the nurses' station allows for closer monitoring and quicker intervention, which can help prevent falls. This is a practical, non-restrictive measure to enhance safety.
A nurse is reinforcing teaching with a client who has bipolar disorder and has a new prescription for lithium. To address possible adverse effects
- A. the nurse should include that which of the following laboratory values will be monitored while the client is taking this medication?
- B. Liver enzymes.
- C. Sodium level.
- D. Uric acid.
- E. Erythrocyte sedimentation rate.
Correct Answer: B
Rationale: Sodium levels must be monitored while taking lithium because lithium can alter sodium and fluid balance. Changes in sodium levels can affect lithium levels and potentially lead to toxicity, making this a critical monitoring parameter.
A nurse is reinforcing teaching with a newly licensed nurse about client confidentiality. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?
- A. I can discuss a client's information with staff who have provided care in the past.
- B. A client retains the legal right to privacy of health information even after they have died.
- C. The provider must give consent to discuss health information with the client's family.
- D. A provider may speak to a client's employer regarding a substance use disorder.
Correct Answer: B
Rationale: Clients retain the legal right to privacy of health information even after death, per HIPAA regulations. This statement reflects an accurate understanding of confidentiality principles.
A nurse is contributing to the plan of care for a client who has a new prescription for lithium. Which of the following interventions should the nurse recommend?
- A. Increase the client's daily caloric intake.
- B. Administer the medication with meals.
- C. Monitor the client for hypoglycemia.
- D. Decrease the client's dietary potassium.
Correct Answer: B
Rationale: Administering lithium with meals is recommended to reduce gastrointestinal upset. Lithium can cause stomach irritation, and taking it with food helps minimize this side effect, improving adherence.